Do the best and brightest leave EMS before retiring?

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Permalink Reply by Skip Kirkwood on June 25, 2009 at 6:54pm

This is just my initial reaction.

I don't think the "best and brightest" are necessarily the ones to leave.

I do think that those that are most motivated to advance their education, and those that are seeking greater compensation as a primary satisfier, and those who have found (perhaps for the first time) academic success in paramedic school, are likely to continue their education.

Another observation. I know quite a few paramedics who became nurses, only to return to the field as a paramedic, because of differences in working conditions, satisfaction, etc. These guys make great paramedics, because they actually have enough education to help them become really excellent medics. And they are still motivated, progressive individuals that help make their organizations better.

I knew plenty of people who took the medic course so that they could get an OK job, that would allow them plenty of time to study, so that they could work their way through some more of their education.

There are losses and then there are losses that we'd like not to happen. For this discussion, you can only start with the number of classmates who actually intended to become career medics, and THEN decided to do something else. If EMS was always a temporary stop, no loss......

Skip

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Permalink Reply by Nathan on June 25, 2009 at 7:07pm

"I knew plenty of people who took the medic course so that they could get an OK job, that would allow them plenty of time to study, so that they could work their way through some more of their education."

I do too, in fact a few in my class stated from the beginning that their main goal for being there (in our class) was a back door to the nursing program (paramedic to RN bridge). At first kinda frustrated me but now I can understand those thoughts, I just wish we could somehow make our profession more than just a stepping stone to such a large number of people. I really hope some of those guys/girls come back to EMS but at the same time it would be hard to blame them if they chose not to.... Personally I am continuing in my education to put myself in a better position to make a positive difference in our field (and because I just want to know more)! And to clarify, I dont think that it is too wrong to consider pay in deciding what field to go into. If you are a medic working two maybe three jobs to support a family then you will not have as good a family life. You will burnout, get hurt, not have as much time to stay current on advances in medicine, and in general not be a very well rounded person. That is just my current thoughts on it, Im open to other angles...

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Permalink Reply by Joe P. on June 25, 2009 at 8:20pm

Skip Kirkwood said:

There are losses and then there are losses that we'd like not to happen. For this discussion, you can only start with the number of classmates who actually intended to become career medics, and THEN decided to do something else. If EMS was always a temporary stop, no loss......

Skip

I don't think that that is a completely fair criteria. I think there is a loss when people who are truly interested in EMS take a pass, or at most, a short field trip, because of the numerous issues when they could go into an equally pleasing field without as many issues.

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Permalink Reply by James Bartus Jr. on June 25, 2009 at 8:21pm

Nathan, You made one of the best, but least mentioned points in your opening: physical stress. Too many people I work with had back problems in their 30's and 40's. Our system (hospital based) even does quarterly ergonomic classes, reimburses for health club membership or fitness programs, and bought the new style of stair-chair and electric stretchers, but no matter the prevention measure this will be a physically demanding job. I for one do not want back surgery at 40 like many of the medics I work with. RT, RN, PA, MD, those profession don't do a lot of hauling people up or down stairs, getting patients out from between toilets and tubs, or dragging them out of the forest with a fractured leg. I'd hate to say it but this profession may be best suited as a stepping stone, for the health and safety of the providers.
I am glad to see you are furthering your education. Keep it up. Those that love the field and leave it will stick around in some fashion to make improvements.

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Permalink Reply by Duncan Hitchcock on June 25, 2009 at 9:33pm

I guess because of the years I've been this business I'm inclined to agree with Skip. I was in EMS and a Paramedic for over ten years before I went to nursing school. I never intended to leave EMS by becoming an RN. I did it for several reasons: to further my education of patient care, to further my education in the health care profession, to obtain a degree, to invest in my future, and to level the playing field between the worlds of prehospital care and hospital care.

There is a certain legitimacy or commonality of understanding and a clearer path to communications brought to interactions in my role as an EMS professional and leader when dealing with those from the hospital professions (nurse and physician) by my having the RN after my name. This is only reinforced by the 20 years that I sent working part-time as an RN in Level II Trauma Centers while continuing my true career in EMS. I have lived and functioned on both sides of the "great abyss".

This experience has provided me with the ability to understand the issues faced by both professions and to affect a change in the understanding of each other's roles, concerns and focuses.

But there are and always will be those just 'stopping in' as either a Paramedic or RN; stopping in as they continue their personal paths towards their personnal goals. This neither dilutes nor is disadvantagous to the EMS industry or the EMS profession. I have met many PAs, physicians, RNs, agency directors, and hospital administrators that spent some time in the trenchs of the EMS world. I have found these people some of the easiest to communicate and work with.

And each day that I go to work at my EMS job, I'm comforted by those that remain dedicated to their chosen profession, their chosen department and the patients they serve. The door must be allowed to open and close. You never know when our next great leader will walk in.

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Permalink Reply by Ben Waller on June 25, 2009 at 10:27pm

In many cases, the best do leave EMS. Some want to continue a medical career as a RN, PA, or physician.
Some want to change careers. Some want better financial rewards, benefits, working conditions, job security, or more time with their families. Some get injured and can't work the field. Some leave for the private sector.

My personal experience includes two high-volume urban systems. One of them was a fire department EMS system with the ability to maintain paramedic certification through the rank of Chief of Department. They routinely had firefighter-paramedics retire, along with other firefighters. The other department was a 3rd service that was nationally respected, particularly in the 1990's. In their entire history, they have had exactly 3 members make it to a full retirement and a couple of others retired disabled from LOD injuries. In my 11 years with that department, we had people leave to be firefighters, police officers, PA's, RN's, small business owners, slumlords, a priest, and a meat cutter at a local supermarket.

In many places, EMS is still a young person's job, and a stepping stone to a more secure, more satisfying career. That doesn't mean that it should be that way, or that it will always be that way. If we get a profession that has comparable standards to nursing, law enforcement, or firefighting, that has decent pay, hours, benefits, retirement, and working conditions, and that has a decent career ladder, then maybe you'll start seeing a higher percentage of EMS folks make it to retirement at the end of a full career.

Most EMS systems don't do a very good job of meeting entry-level employee's needs as explained by Maslow (the Heirarchy of Needs) or Deming (internal customers). My hat is off to the ones that do, but they aren't the norm, unfortunately.

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Permalink Reply by Rob Robbins on June 26, 2009 at 12:43am

Nathan,
You’re right, the models used today to deploy ambulances is nothing less than harmful to your health and in some cases criminal. I was disappointed to see only two people responded to my discussion question because the largest ambulance provider (private) in the country has an employee tenure of less than 15 months.

Frequently, most just see the “Dr.” before my name and assume I became a paramedic “got in and got out” and have no idea what it takes both physically and mentally to do the “job”. I do my friend, I spent 30 years doing the “job” and now I have a DSc, that follows my name, but I will always be a paramedic and a firefighter in my heart. So the short answer to your question is no. I will be posting discussions regarding the concept of allostasis and allostatic load and how it is applied to the firefighter, EMS provider and police officer.

There is a specific test that analyzes both stress biomarkers and biometrics and scores your health trajectory, predicting your future health (3-5 years) with an accuracy of greater than 80%. The science has taken 25 years to develop backed by the world leading neuroscientist and physicians…and the retail version is now available. There is one biotech firm currently that offers this test and “score”. The problem is they market only to corporations and there HR department…and we know where this is going when we consider the cost per employee, especially the private sector EMS agency. Unfortunately, the private sector unions are not strong enough and most members are apathetic and uninvolved…where will it end, and will your next employer use this “health risk assessment” as a pre-employment screening?

Much more to come, stay tuned because I want the "good ones" to stay, not the just ok ones with no ambition!

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Permalink Reply by Skip Kirkwood on June 26, 2009 at 7:58am

Wow! Nathan, where is the evidence that deployment methods are "harmful" or "criminal." Those are very strong words, and since you've got a D.Sc., I'm assuming that you know some things about research, evidence, and the standard of proof. Please, if you have this knowledge, put it out there for us. I will be the first to acknowledge that vehicle-based deployment (as opposed to facility-based deployment) is unpleasant, but that's it. If it is so bad for EMS, why is it the norm for cops and so many others? Again, evidence please.

The best I've seen is a couple of studies that show small increases in back problems, and those are not even from the U.S.

I do think the industry needs to know more about the tests you describe. THAT would be worth a full article here, or in JEMS, or somewhere. I don't think that it's just apathy - I stay pretty well informed and I've never heard of such. Maybe we could negotiate a group deal through NAEMT or someone.

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Permalink Reply by Nathan on June 26, 2009 at 2:13pm

Well, Skip I didnt say it was criminal, that was Rob and he said "in some cases even criminal" but none the less I would also be interested in seeing these instances because I dont doubt they exist somewhere out there. I think we all can admit that EMS has a pretty high rate of back injury. Both my parents are Physical Therapists and they can confirm that. But I do think we need studies clearly showing this to be true since I have no doubt that it is. But lets not get too far off topic?

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Permalink Reply by Skip Kirkwood on June 26, 2009 at 3:32pm

You're right...that was Rob.

Off topic? The topic was the best and brightest leaving EMS, and Rob suggested that they may for physical reasons.

I can't admit anything of the sort without data. I've just looked at 5 years of workers' comp data from my 45,000 calls per year agency. Guess what? Not many backs. Shoulders, wrists, knees - and we're not a streetcorner posting agency. So in God I trust....all others bring evidence (not anecdotes).

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Permalink Reply by Nathan on June 26, 2009 at 3:43pm

Your right its not off topic.

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Permalink Reply by Ben Waller on June 27, 2009 at 4:08pm

Skip,

I'd postulate that most EMS vehicles are based on trucks, while police vehicles are based on passenger cars. Comfort for long periods is an ergonomic requirement for passenger cars, because lots of them are used for long trips where occupant comfort is an important requirement. The "comfort" built into the design will translate into any long-term use, not just long mileage.

The trucks upon which most ambulances are based are typically designed for much shorter occupant stays. They're designed to haul the driver, his tools, and maybe a few passengers to a job site where he'll work a few hours while using the truck for a few intermittent trips to the parts store or for a lunch run.

The analog to this is the advent of dispatcher chairs after back problems became a near-epidemic in that career path. Typical office chairs are not designed for 8 or 12-hour dispatch shifts.

If we're going to use street-corner deployment, we need to do it in vehicles that are designed for long-term occupant comfort. I'd rather see station-based deployment with an adequate number of units to handle the call volume and maintain reasonable response times when the system is busy.

Skip Kirkwood said:

Wow! Nathan, where is the evidence that deployment methods are "harmful" or "criminal." Those are very strong words, and since you've got a D.Sc., I'm assuming that you know some things about research, evidence, and the standard of proof. Please, if you have this knowledge, put it out there for us. I will be the first to acknowledge that vehicle-based deployment (as opposed to facility-based deployment) is unpleasant, but that's it. If it is so bad for EMS, why is it the norm for cops and so many others? Again, evidence please.

The best I've seen is a couple of studies that show small increases in back problems, and those are not even from the U.S.

I do think the industry needs to know more about the tests you describe. THAT would be worth a full article here, or in JEMS, or somewhere. I don't think that it's just apathy - I stay pretty well informed and I've never heard of such. Maybe we could negotiate a group deal through NAEMT or someone.

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